不同留针时间针刺对缺血性中风患者血液流变学的影响

Effect of Different Acupuncture Needle-retaining Time on Hemorheology in Ischemic Stroke Patients

目的:观察不同留针时间针刺对缺血性中风患者血液流变学的影响,探索针刺治疗缺血性中风的时效关系。方法:251例缺血性中风急性期、恢复期患者,按轻度、中度和重度分3层随机分为留针20、40和60 min 3组。取肩髃、曲池、外关、合谷、伏兔、足三里、解溪、太冲等穴。进针后提插或捻转行针以使得气,施平补平泻手法,加疏波电刺激,3组留针时间分别为20、40和60 min,每天针刺1次,10次为1疗程。其中34例患者在针刺治疗前后分别进行血液流变学检测。结果:3组患者分别基本痊愈3、4、9例,显著进步15、17、21例,进步24、33、40例,无变化41、26、12例,有效率分别为50.60%、67.50%和85.37%,显效率分别为21.68%、26.25%和36.59%,20 min组和40 min组与60 min组比较差异存在显著性统计学意义(P<0.01,0.05)。针刺后患者的全血高切黏度、全血低切黏度、血浆黏度、红细胞压积和纤维蛋白原等血液流变学指标基本都降低,组间差异也均存在显著性统计学意义,以60 min组作用最明显。结论:改善血液流变学是针刺治疗缺血性中风的机制之一,且具有一定的时效关系。

Objective： To observe the effect of different needle-retaining duration on hemorheology in ischemic stroke patients in order to explore its underlying mechanism in the treatment of ischemic stroke. Methods： A total of 251 ischemic apoplexy patients were, according to their state （mild, moderate and severe） of disease, randomly divided into 20 min, 40 min and 60 min groups respectively. Acupoints Jianyu （LI 15）, Quchi （LI 11）, Waiguan （TE 5）, Hegu （LI 4）, Futu （ST 32）, Zusanli （ST 36）, etc. were punctured and stimulated electrically with parameters of 2 Hz, 2-6 mA for 20 min, 40 min and 60 min separately, once daily for 10 times. In addition, the patients were also treated with medicines for lowering intracranial pressure as manicol, etc. Higher shearing rate （HSR） and lower shearing rate （LSR） of whole blood viscosity （rib）, plasma viscosity （rip）, hematocrit （HCT） and profibrin were detected separately before and after the treatment. Results： After acupuncture treatment, of the 83, 80 and 82 cases in 20 min, 40 min and 60 min groups, 3 （3.61%）, 4 （5.00%） and 9 （10.98%） were cured basically, 15 （18.07 % ）, 17 （21.25 % ） and 21 （25.61% ） experienced remarkable improvement in their symptoms and signs, 24 （28.92 % ）, 33 （41.25%） and 40 （48.78%） had an improvement, 41 （49.40%）, 26 （32.50%） and 12 （14.63%） failed in the treatment, with the markedly effective rates being 21.68%, 26.25% and 36.59% and the effective rates being 50.60%, 67.50% and 85.37% separately. The effective rate of 60 min group was significantly higher than those of 20 min and 40 min groups （P〈0.01, 0.05）. Self-comparison showed that HSR, LSR of rib, rip, HCT and profibrin levels decreased considerably in com- parison with pre-treatment in each group （P〈0.01）. Difference values of HSR, LSR, rip, HCT and profibrin （pre-treatmentthose of post- treatment） in 60 min group were significantly higher than those of 20 min and 40 min groups （ P〈0.05, 0.01 ）, and those of HSR, HCT and profibrin of 40 min group were markedly higher than those of 20 min group （P〈0.01, 0.05）. The therapeutic effect of 60 min group was the best. Conclusion： Acupuncture can effectively improve stroke patients＇ symptoms and signs, and lower various parameters of hemorheology.